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Health Professionals for a New Century

Harvard School of Public Health dean Julio Frenk addresses public-health researchers and educators at The Second Century Symposium.

Photograph by Stephanie Mitchell/Harvard Public Affairs and Communications

The future of public-health education was the topic of the day for
public-health researchers, educators, and practitioners from around the nation
in “The Second Century Symposium: Transforming Public Health Education,” held November 1 at the Harvard School of Public Health (HSPH).
In a wide-ranging discussion, four panels tackled themes ranging from the
transformative potential of online technologies, to the changing nature of
professional education, to the unique challenges facing the field of public
health itself.

HSPH dean Julio Frenk set the
stage by offering an overview of his school’s three-year-long centennial curricular review. Advances in cognitive science combined with technological
developments have spurred what he called a “deep reflection on the future of
higher education.” The school as a result will shift toward an “open
architecture” of learning, he announced, characterized by modular units
structured around core competencies; it will also employ “blended” approaches
that mix online and on-site learning for what Frenk called “informative,
formative, and transformative” goals. Redesigned degree programs will train
students more specifically for careers as either researchers or practitioners;
in particular, a new Dr.P.H. degree for public-health leadership begins
accepting applications this fall. Educational innovation features prominently
in HSPH’s recently launched $450-million capital campaign, unveiled in late October on the occasion of the school’s centennial, and has
already drawn significant philanthropic support.

The first panel, “The Digital Revolution and the Science of
Education,” considered the influence of technology on the practice and nature
of higher education. HSPH produced one of the first EdX online courses, “Health
in Numbers,” a course in epidemiology and biostatistics that drew 55,000
registrants. Sukon Kanchanaraksa, director of the Center for Teaching and
Learning at the Johns Hopkins Bloomberg School of Public Health, addressed the
issue of accreditation; the next step for MOOCs, he said, would be for students
to have their accomplishments recognized.

Yet in his morning presentation, Frenk was already looking beyond
these massive open online courses, or
MOOCS, to what he called small private online classes, or SPOCs. These smaller
courses would use online modules as part of a “flipped classroom” approach, in
which students learn course material on their own time and engage in
discussions in class. “We’re already post-MOOC,” affirmed panelist Robert Lue, Menschel
faculty director at Harvard’s Bok Center
for Teaching and Learning. He argued
that digital advances offer an opportunity to rethink the mission of education:
“Online transforms the in-person.”

New technologies allow educators to personalize education and
tailor reinforcement for maximum retention, said Rishi Desai, a medical
educator at the online nonprofit educational platform Khan Academy. He compared
current online educational approaches to advertising billboards: though they
reach many people, the message is the same for everyone. “What Khan Academy is
trying to do is push [online learning] toward what we have on our phones:
personalized marketing that really targets you.”

But later panelists seemed to argue that even these new
technologies would not serve the many demands of professional education. The
panel on “Reinventing the Classroom, Campus, and Community for Learning and
Teaching” presented professional education as a series of apprenticeships
focused on three objectives: knowing, doing, and being. The third
apprenticeship, focusing on character, ethics, and the identity of the
profession, is “distinctly third,” though often decisive in future success,
said William Sullivan, senior scholar at Wabash College’s Center for Inquiry in
the Liberal Arts and founding director of the Educating Tomorrow’s Lawyers
project at the University of Denver.

Sullivan argued that in moving beyond content and competencies,
professional education would require pedagogical innovations. He suggested a
role for simulations and programs analogous to medical residencies, echoing the
focus on mental presence set forth by fellow panelist Erin Driver-Linn,
director of the Harvard Initiative for Learning and Teaching. Similarly, David Garvin, Christenson professor of business
administration at Harvard Business School (HBS), offered lessons from HBS’s use of the case method, “in essence, a flipped classroom approach.” “Engagement goes
up,” he said, when students have read the case in advance and can have
interesting discussions. Denise Koo ’84, director of the division of scientific
education and professional development at the Centers for Disease Control and
Prevention, related her own memorable experience of studying an actual disease
outbreak during her M.P.H. studies. “I was totally hooked,” she said.

But even in a self-professedly data-driven field, the difficulty
of evaluating factors like ethics and professionalism was readily apparent in a
later panel, “Assessing Learning for Action and Input.” Nancy Kane, HSPH
associate dean for case-based teaching and learning, pointed out that didactic
and case-based teaching methods have different goals. “I don’t think my school,
with its diversity of programs, is ready to have a single kind of assessment
tool,” she said.

Hobbs professor of cognition and education Howard Gardner took her
concerns a step further, urging HSPH to take the “right-hanging fruit” rather
than the “low-hanging fruit” and to “share the confusion” inherent in education
rather than devising simple metrics. “The danger of the low-hanging fruit,” he
said, “is that you look at what’s easiest to assess rather than what you really
value.” (See this report on Gardner’s recent book, The App Generation: How Today’s Youth
Navigate Identity, Intimacy, and Imagination in a Digital World.)

The final panel, “Public Health Education Unbound: Transforming
the Field,” brought these reflections to bear on the field of public health in
particular. Sue Goldie, Lee professor of public health and director of the Harvard Global Health Institute, argued that the skills required for teaching and
learning—communication, introspection, and self-reflection, in particular—are
essential to an interdisciplinary field like public health. “With creativity,”
she said, “we can create teaching and learning spaces that…enrich the whole
being of our profession.” University provost Alan Garber
pointed out that current pedagogical innovations like MOOCs are bound to
change; all of higher education, he said, is in a period of “great
experimentation.”

The result was a day that produced more questions than answers.
The HSPH curricular reform has emphasized a shift from a knowledge-based to a
competency-focused curriculum, but panelists repeatedly argued for the
importance of elusive factors like professional values. Many of the suggested
pedagogical innovations for active engagement—simulations, field learning, and
the case method, for instance—are already being piloted at HSPH and other
Harvard schools, but panelists like Koo articulated the need to balance
“willy-nilly” learning-by-doing approaches with more structured reflection.

One thing was certain: “We need to convene again,” said closing
speaker Lincoln Chen, M.D. ’68, president of the China Medical Board. “And this
time, it shouldn’t be another hundred years.”